emDocs - February 16, 2016 - Author: Hua A - Edited by: Koyfman A and Long B
"A 41 yo M is brought in by EMS after an attempted hanging. He was found by his father-in-law, who cut him down with a neighbor’s assistance. Unwitnessed hanging, estimated 1-45min of hang time.
How should this case be managed? What are the issues to be immediately addressed, and of what complications should an emergency physician be aware?
INITIAL EMERGENCY DEPARTMENT CARE – ABCs
- Endotracheal intubation (ETI) may become necessary with little warning
- If ETI unsuccessful, consider cricothyroidotomy; if unsuccessful, percutaneous trans-laryngeal ventilation may be used temporarily
- Fluid resuscitation must be performed judiciously – risk of ARDS and cerebral edema
- Monitor for cardiac arrhythmias
- Altered / comatose patient => treat as cerebral edema with elevated ICP"